Annual checks for patients with all-metal hips

Hip replacement X-ray The Medicines and Healthcare products Regulatory Agency says 49,000 patients are in the risk group

A huge amount of media attention in recent months has focussed on PIP breast implants, but far less on another potentially faulty device - hip replacements.

Around 70,000 people a year get a new hip and they are among the most successful operations in modern medicine.

But concern has been emerging for some time about certain types of metal-on-metal hips, in particular those where the ball head has a diameter of 36mm or more.

Some 49,000 patients in the UK have these implants and they've been shown to have a much higher failure rate than metal and plastic or ceramic implants.

In addition, the constant wear of the all-metal hip can allow microscopic metal ion particles to enter the bloodstream, potentially causing tissue damage.

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new advice saying patients with these large head diameter metal-on-metal hips will need monitoring for the life-time of the implant. At present the monitoring stops after five years if the patient has no adverse symptoms.

In future patients will continue to have annual blood tests to check for the level of metal ions - a high level can be indicative of tissue damage around the hip which - left untreated - could make replacement more difficult. If the ion levels are rising then patients will be given an MRI scan to check for damage.

Professor Sir Kent Woods, MHRA chief executive, says these checks should reveal problems early on:

"There is a rough correlation between the pattern of wear of the joint and the level of ions in the blood. We think the ions can at high levels produce local effects on tissue which is why we recommend regular screening so if the levels are high we can recommend repeat surgery at an early stage."

The MHRA said all-metal hips had a failure rate of about 12% after seven years, three times that of metal and plastic or ceramic hips.

It is unlikely to be a coincidence that the new advice comes on the day that a combined BBC Newsnight and British Medical Journal investigation reports that problems with such devices have been long known, but no action taken to block their use. You can see the report on Newsnight at 10.30pm on BBC2.

But Dr Susanne Ludgate, clinical director of the MHRA, says they had first become aware in 2008 of a small number of cases where patients suffered swelling around the hip and tissue damage.

Patients with metal-on-metal hips should be contacted in due course by their orthopaedic surgeon but the MHRA said any patient who was concerned should see their GP.

Professor Sir Kent Woods, Chief Executive, MHRA

Fergus Walsh Article written by Fergus Walsh Fergus Walsh Medical correspondent

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  • rate this

    Comment number 2.

    Hi, I had my right hip resurface in 2006, In May last year i had to have revision surgery as i was in so much pain with my hip and i high amounts of cobalt and chromium in my blood and i was living on painkillers. I have now a ceramic hip implant but i am not 100% as i think the damage has already been done. I am due to see my Consultant in May and i will be having blood tests to check metal ions

  • rate this

    Comment number 3.

    I have just listened to the Paxman interview on TV and I am astounded at what I heard. It appears to be nothing less than engineering incompetence ! How on earth can a device, of this nature, be released into the market without significant meaningful testing. I am a chartered engineer and I am astounded at the facts revealed in the interview. I can only hope the decision can be justified.

  • rate this

    Comment number 4.

    I got the Birmingham hip 7 years ago which is a metal on metal implant and I have been having tests done for these ions for the last 2 years. Although they say I am ok I have always had pain and wonder could this be a related problem.Anybody know anything.

  • rate this

    Comment number 5.

    Hello I had my right hip resurfaced in 1996 . My hospital has always done blood checks and hip reviews every year . I've never had a problem until last year when it started to fail . But then I was 26 when my hip was done and I haven't looked after it . I would like to point out that its not the hip replacement thats failing but the bone its self .

  • rate this

    Comment number 6.

    Hip resurfaced metal on metal January 2010. Have suffered severe cramp-like pain on thigh for a number of months, not in groin or wound area .Contacted hospital and had date for MRI within two weeks, then appt with consultant the week after.
    Hospital definitely taking this seriously considering how long had to wait for replacement. NE England.


Comments 5 of 11



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